In advance of World AIDS Day on December 1, the UNAIDS released its annual report on the state of the global HIV/AIDS pandemic. The latest figures show that while more people than ever are receiving antiretroviral therapy (ART), further progress is jeopardized by cut-backs in funding worldwide.

Combined with effective antiretroviral prophylaxis to prevent mother-to-child HIV transmission during pregnancy, delivery, and breast-feeding, new advances in treatment recently led U.S. Secretary of State Hillary Clinton to announce that achieving an "AIDS-free generation" is possible and should be a priority of U.S. international aid efforts.

UNAIDS Report

The 2011 Joint United National Programme on AIDS (UNAIDS) World AIDS Day Report focuses on "how to get to zero faster, smarter, and better," referring to the agency's vision of reaching zero new HIV infections, zero discrimination against people with HIV, and zero AIDS-related deaths.

Looking at the big picture, UNAIDS estimates that in 2010 there were 34 million people worldwide living with HIV, 2.7 million new infections, and 1.8 million deaths due to AIDS-related illnesses.

According to the new report, nearly half of HIV positive people who were eligible for antiretroviral treatment in low- and middle-income countries -- an estimated 6.6 out of 14.2 million individuals -- had access to life-saving drugs in 2010, up from just over one-third in 2009. ART has prevented an estimated 2.5 million deaths since the mid-1990s, and there is now early evidence that treatment is having an impact on the number of new HIV infections.

HIV incidence and AIDS-related mortality have fallen to their lowest levels since the height of the pandemic, the report says. UNAIDS estimates that new infections have decreased by 21% since their peak in 1997, while deaths due to AIDS-related illnesses have decreased by the same amount since 2005. In South Africa -- the country with the highest incidence -- the infection rate has fallen by about 30%, while new infections in South and Southeast Asia have declined by more than 40% (including a 56% drop in India).

The report also estimates that 48% of HIV positive pregnant women have access to effective antiretroviral prophylaxis, and ART has prevented some 400,000 new infections among children in low- and middle-income countries since 1995.

"We have seen a massive scale up in access to HIV treatment which has had a dramatic effect on the lives of people everywhere," said UNAIDS Executive Director Michel Sidibé. "Never before in the history of AIDS have we reached a moment where we are able to stand up and say with conviction the end of AIDS is in sight."

"The gulf between treatment and prevention has ended," he added. "The divide between health and AIDS has narrowed, as AIDS comes out of isolation and into integrated and holistic health services."

Funding in Decline

In the face of contracting budgets worldwide, UNAIDS has developed a new framework for making the most of limited funds, directing investments to "high-impact, evidence-based, high-value strategies." The agency estimates that this approach could prevent at least 12 million new HIV infections and more than 7 million AIDS-related deaths between 2011 and 2020. A key element of the framework is its focus on high-risk populations including sex workers and their clients, men who have sex with men, and injection drug users.

"The progress we have made so far is proof that we can realize our vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths, said United Nations Secretary General Ban Ki-moon. "Among populations at risk, the tide is shifting. Access to HIV prevention services are helping young people, sex workers and their clients, people who inject drugs, men who have sex with men, and transgender people to take control of their health for greater well-being."

UNAIDS estimates that achieving universal access to HIV prevention, treatment, care and support would require US$ 22-24 billion by 2015. If full implementation of the new framework is achieved, the agency projects that global resource requirements should peak in 2015 and then gradually decline.

But donor funding for HIV/AIDS decreased by 10% during 2010, and the global economic crisis portends further reductions.

The same week the UNAIDS report was released, the Global Fund to Fight HIV, Tuberculosis and Malaria announced the cancellation of its next round of grants due to budget shortfalls. The Fund covers about half the cost of antiretroviral therapy for resource-limited countries, as well as prevention programs.

"This financial blow to the Global Fund comes at the worst possible time in the HIV response," said International AIDS Society President Elly Katabira. "Just as UNAIDS is reporting that new cases of HIV are starting to decline, and as we are seeing that the effective and early treatment of people living with HIV can stop transmission to their partners, the financial support that we need to continue this progress and to turn scientific fact into action has been pulled out from underneath us."

The suspension is due in part to the failure of donor countries to deliver US$ 2.2 million worth of committed funding. Global Fund managers, meeting in Ghana last week, also indicated that misappropriation and failure to disperse funds to end users must be corrected, as the Fund attempts to shift from crisis mode to more sustainable operations; some donor countries have withheld funding due to reports of financial mismanagement.

Countries with the largest HIV/AIDS burden and greatest need will be eligible for emergency allocations for continuation of essential services including antiretroviral treatment until the next round of funding in 2014, but scale-up will not be possible. Upper-middle-income countries such as Argentina, Brazil, China, Mexico, and Russia will no longer be eligible for funding.

"It is deeply worrisome that inadvertently, the millions of people fighting with deadly diseases are in danger of paying the price for the global financial crisis," said Global Fund Executive Director Michel Kazatchkine. "There are millions of people dependent on Global Fund resources to stay alive and healthy, and the Global Fund will redouble its efforts to increase the available funding to continue to scale up HIV, TB and malaria interventions."

11/29/11

Sources

UNAIDS. Nearly 50% of people who are eligible for antiretroviral therapy now have access to lifesaving treatment. Press release. November 21, 2011.

United Nations. Secretary-General. Message on World Aids Day. December 1, 2011.

Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund Adopts New Strategy To Save 10 Million Lives By 2016. Press release. November 23, 2011.

International AIDS Society. As the Global Fund cancels its 11th funding round due to lack of resources, the International AIDS Society (IAS) urges donors and governments to allow the Global Fund to continue its lifesaving HIV work. Press release. November 24, 2011.